Provider Onboarding & Credentialing Specialist

$36,000 - $59,400/Yr

Unum - Portland, ME

Full-time - Entry Level

Portland, ME

5,001-10,000 employees

Insurance Carriers and Related Activities

About the position

The Provider Onboarding and Credentialing Specialist at Unum plays a crucial role in ensuring a seamless onboarding process for new in-network dental PPO, dental DHMO, and vision providers. This position is responsible for managing the entire onboarding process, which includes taking completed provider applications, entering data into the Salesforce System for tracking, and managing any incomplete information. The Specialist will also be tasked with gathering necessary information from providers and conducting initial credentialing and recredentialing in compliance with internal standards, policies, and procedures. This involves performing credentialing verifications, preparing files for various internal and external entities, and assisting in conducting Credentialing Delegation Reviews. Additionally, the Specialist will prepare and deliver monthly and quarterly reports as requested, ensuring that all processes align with compliance standards. In this role, the Specialist will manage pending and incomplete contracts, ensuring that all missing contracting documents are efficiently gathered. They will identify errors in initial contracting and work closely with Provider Network Recruitment to communicate and follow up on missing contract elements. The Specialist will input contract data into provider databases, ensuring accuracy and timeliness for monthly metrics and recruitment reporting. They will also be responsible for notifying providers of credentialing decisions within compliance timeframes and performing re-credentialing every 36 months in accordance with NCQA standards. The position requires a strong commitment to maintaining provider and patient confidentiality while providing positive and supportive communication to providers at all times. Collaboration with other departments and outside agencies is essential to meet the identified needs of providers and their patients, ensuring a cooperative environment among credentialing staff.

Responsibilities

• Manage pending/incomplete contracts and workflow to efficiently gather all missing contracting documents
• Identify errors in initial contracting and missing items for completion
• Contribute to individual quality/production expectations to ensure the achievement of organizations turnaround time expectations
• Perform a check on contracts to make sure appropriate fee schedules for area is utilized
• Work closely with Provider Network Recruitment to communicate and follow-up on missing contract elements
• Input contract data into provider databases while ensuring the accuracy of the data
• Responsible for entering in contracts in a timely manner for monthly metrics and recruitment reporting
• Assist with Credentialing Delegation Reviews by presenting credentialing files to various Delegated Entities
• Work directly with providers to ensure all necessary credentialing information has been received prior to beginning the credentialing process
• Enter provider data into appropriate data management systems
• Perform all credentialing verifications necessary to complete the credentialing process while maintaining the appropriate compliance standards
• Prepare and present providers records for Credentialing Committee Review
• Notify providers of credentialing decisions within compliance timeframes
• Perform provider re-credentialing, at least every 36 months in compliance with NCQA standards
• Assist in monitoring of license expirations and any change in status and take action when appropriate
• Educate providers regarding criteria and credentialing policies and procedures when necessary
• Work with Network Management to ensure providers' initial information and updates are sent for processing timely and accurately
• Assist Network Management and Support staff with provider data management as it relates to adding new providers in System of Record
• Send all approval and welcome kits to providers in a timely manner
• Maintain provider and patient confidentiality
• Provide positive, supportive communication to providers at all times
• Collaborate with other departments and outside agencies to meet identified needs of the providers and their patients, while also ensuring credentialing staff cooperation
• Perform other duties as assigned, including special projects and initiatives.

Requirements

• Bachelor's degree preferred or equivalent experience
• 0-2 years' experience in Provider Relations and Credentialing or equivalent experience preferred
• Excellent verbal and written communication skills
• High level of accuracy and attention to detail
• Ability to gain high level of knowledge involving intricate aspects Systems of Record
• Strong customer service philosophy
• Critical thinking and problem-solving abilities
• Ability to thrive in a fast-paced environment and meet assigned deadlines
• Demonstrated ability to adopt change to improve process, efficiency, and service
• Demonstrates consistency in accuracy, speed, and quality of work.

Benefits

• Health, Vision, Dental insurance
• Short & Long-Term Disability insurance
• Performance Based Incentive Plans
• Generous PTO including paid time to volunteer
• Up to 9.5% 401(k) employer contribution
• Mental health support
• Career advancement opportunities
• Student loan repayment options
• Tuition reimbursement
• Flexible work environments